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Biomedical subjects

E Frank

Publications and source records attributed to E Frank.

At least 469 records · Page 26Linked to original sources
PubMedDate not supplied

Family history in recurrent depression.

The authors report morbid risks found for depression, alcoholism, and bipolar disorder in first-degree relatives of 179 probands with recurrent depression. Comparisons were made for relatives' gender, probands' gender, and probands' age at onset. Results showed overall morbid risks of 20.7% for non-bipolar depression, 15.4% for alcoholism, and 1.1% for bipolar disorder. Female relatives were found to be at greater risk for depression than males, while the reverse was true for alcoholism. Sex of proband had no effect. Risk to relatives of early-onset probands was significantly elevated compared to late-onset probands. Various cutoffs for ages at onset were examined, and the effect became more marked as the cutoff age was decreased to 20.

Adult↗
PubMedDate not supplied

Prodromal and residual symptoms in bipolar I disorder.

The objective of the current study was to better understand the nature of prodromal and residual symptoms of mania and depression, as reported by patients with bipolar I disorder and their family members. Prodromal and residual symptoms of mania and depression were elicited from 74 patients with bipolar I disorder. In 45 cases, an adult family member provided similar information. Three clinicians classified the symptoms into six broad categories: behavioral, cognitive, mood, neurovegetative, social, and other. The clinicians also categorized symptoms as typical or idiosyncratic. Seventy-eight percent of the patients reported prodromal depressive symptoms and 87% reported prodromal manic symptoms; greater than half of the patients disclosed residual symptoms of depression (54%) and mania (68%). Within each of these four illness categories, cognitive symptoms were consistently the most common symptoms reported by patients. A substantial number of symptoms were idiosyncratic, particularly those reported for residual depression. Agreement between patient and family members on reported symptoms was strong for the prodromal phase of both polarities, but less so for the residual phases. These preliminary results suggest that patients with bipolar I disorder and their family members can identify prodromal and residual symptoms, that these symptoms are quite common, and that prodromal symptoms may be more prevalent or easier to identify than residual symptoms. Cognitive symptoms were consistently the most common symptoms reported by patients.

Adult↗
PubMedDate not supplied

Panic-agoraphobic spectrum: reliability and validity of assessment instruments.

DSM IV is a simple, reliable diagnostic system with many advantages. However, DSM diagnostic criteria may not provide sufficient characterization of clinically significant symptoms. We have undertaken a project to assess an array (spectrum) of clinical features associated with different DSM Disorders. The purpose of this paper is to report on reliability of assessment instruments for Panic-Agoraphobic Spectrum (PAS), to document convergent validity of PAS symptom groupings, and to confirm the relationship between PAS and DSM IV Panic Disorder (PD). We studied 22 normal controls and 95 outpatients who met criteria for Panic Disorder with and without lifetime Major Depression, and Major Depression or Obsessive Compulsive Disorder without lifetime Panic Disorder. Assessment instruments had excellent reliability and there was good concordance between interview and self-report formats. PAS scores were highest in subjects with PD, followed by outpatients without PD, and were lowest in normal controls. PAS scores varied among PD patients, and a subgroup of patients without PD scored high on PAS. We conclude that PAS can be reliably assessed, and that it describes a valid, coherent constellation of features associated with DSM IV Panic Disorder, but providing additional important clinical information.

Agoraphobia↗
PubMedDate not supplied

Reliability and validity of the Panic Disorder Severity Scale: replication and extension.

UNLABELLED: The Panic Disorder Severity Scale (PDSS) is a recently developed seven-item instrument to rate overall severity of Panic Disorder. The scale has previously shown good psychometric properties in a sample of Panic Disorder patients with no more than mild agoraphobia. The purpose of this paper is to confirm reliability and validity, to provide an estimate of a cut-score discriminating the presence or absence of current DSM-IV Panic Disorder, and to determine the factor structure of the instrument. PROCEDURES: 104 psychiatric outpatients, including 54 with current Panic Disorder, underwent structured diagnostic assessment and the PDSS interview. The PDSS was repeated within 3-17 days. RESULTS: we confirmed reliability and validity of the instrument and found a one-factor solution fit the data. A cut-off score of eight identifies patients with current panic with a sensitivity of 83.3%, and a specificity of 64%. CONCLUSION: the PDSS is a simple, reliable instrument for use in Panic Disorder studies. A cut-score of eight may be useful as a tool to screen patients in settings such as primary care, for diagnosis-level symptoms.

Adolescent↗
PubMedDate not supplied

MRI study of posterior fossa structures and brain ventricles in bipolar patients.

Previous brain imaging studies have suggested anatomical abnormalities in posterior fossa structures and brain ventricles in bipolar patients. Such abnormalities could possibly be implicated in the pathophysiology of bipolar disorder. Twenty-two DSM-IV bipolar outpatients (mean age+/-S.D.=36+/-10 years) and 22 healthy controls (mean age+/-S.D.=38+/-10 years) underwent an 1.5T MRI (3D-gradient echo-imaging SPGR), performed in the coronal plane (TR=25 ms, TE=5 ms, slice thickness=1.5 mm). The brain structures of interest were traced blindly with a semi-automated software. No significant differences were found between bipolar patients and healthy controls for any posterior fossa measures, or for measures of third or lateral ventricles (MANOVA, age covariate, P>0.05). Age was directly correlated with 3rd ventricle volumes in bipolar patients (Pearson correlation coefficient=0.458, P=0.032), but not in healthy controls (Pearson correlation coefficient=0.313, P=0.155). There was a significant direct correlation between the number of prior illness episodes and right lateral ventricle volumes (Partial correlation coefficient=0.658, P=0.011). Familial patients had smaller left and right cerebellar hemispheres and total vermis volumes, and larger left lateral ventricle volumes compared with non-familial ones (MANOVA, age covariate, P<0.05). In this preliminary study, we were not able to replicate previous findings of abnormalities in cerebellum or brain ventricles in bipolar individuals. However, there were suggestions that abnormalities in cerebellum, vermis, and lateral ventricle sizes may be present in familial cases of the disorder, which should be further examined in future studies with larger patient samples.

Adult↗
PubMedDate not supplied

Insulin-like growth factor 1 and growth hormone binding protein in depression: a preliminary communication.

This study was undertaken in order to advance our understanding of the distal growth hormone axis in depression. Insulin-like growth factor 1 (IGF-1) and growth hormone binding protein (GHBP) were measured in a group of 19 depressed women and a group of 16 healthy women. Using a generalized linear model, IGF-1 levels were negatively correlated with age (p = 0.0001), influenced by menstrual phase (p = 0.016), and significantly increased in the depressed group (p = 0.02). Using the same type of analysis, GHBP was significantly related to menstrual phase (p = 0.0001) and body mass index (p = 0.0001), but was not significantly different in patients and controls. IGF-1 and GHBP were positively correlated among healthy subjects (r = 0.46, p = 0.08), but not among depressed patients (r = -0.16, p = 0.51), although these correlation coefficients were not statistically significantly different from each other. These findings confirm the importance of several physiological factors in the regulation of IGF-1 and GHBP, and suggest that depression further influences this regulation.

Adult↗
PubMedDate not supplied

Status of minor depression or dysthymia in primary care following a randomized controlled treatment.

This report describes the rates of recovery and remission from minor depression or dysthymia in primary care patients three months after completing a randomized controlled treatment trial. The subjects were primary care patients who received > or =4 treatment sessions with Problem-Solving Treatment, paroxetine, or placebo and who completed an independent assessment 3 months after the study (201 with minor depression, 229 with dysthymia). The 17-item Hamilton Rating Scale for Depression (HAMD), semistructured questions about postintervention depression treatments, and baseline medical comorbidity, neuroticism, and social function were the primary measures. For minor depression 76% and for dysthymia 68% of subjects who were in remission at the end of the 11-week treatment trial were recovered (HAMD < or =6) three months after the treatment trial. Of patients who were not in remission at 11 weeks, for minor depression 37% and for dysthymia 31% went on to achieve remission at 25 weeks. The majority of patients chose not to use antidepressants or psychotherapy after the trial. Patients with minor depression that had greater baseline social function and lower neuroticism scores were more likely to be recovered. For patients with minor depression, these findings suggest a need for some matching of continuation and maintenance treatment to patient characteristics rather than uniform, automatic treatment recommendations. Because of the chronic, relapsing nature of dysthymia, practical improvements in encouraging effective continuation and maintenance phases of treatment are indicated.

Adolescent↗
PubMedDate not supplied

The treatment effectiveness project. A comparison of the effectiveness of paroxetine, problem-solving therapy, and placebo in the treatment of minor depression and dysthymia in primary care patients: background and research plan.

This report describes the background, rationale, and research plan for a comparative treatment trial of the effectiveness of paroxetine, problem-solving therapy (PST-PC), and placebo in the treatment of minor depression and dysthymia in primary care patients. Patients were recruited from a variety of primary care practice settings in four separate geographic locations (Hanover, New Hampshire; Pittsburgh, Pennsylvania, San Antonio, Texas; and Seattle, Washington). Patients were randomly assigned to each of the three intervention conditions the medication/placebo conditions were double-blinded. The treatment trial was 11 weeks, with independent assessments of patient clinical status at baseline, 6 weeks, and 11 weeks. There was a follow-up at 25 weeks. Since there are relatively few placebo-controlled trials in primary care settings on patients with these disorders, the background of this project and a description of it are presented at this time, prior to the availability of outcome data, to provide methodological detail and to increase awareness in the research community of this treatment trial, with results to appear subsequently.

Antidepressive Agents↗
PubMedDate not supplied

Progress in the psychotherapy of mood disorders: studies from the Western Psychiatric Institute and Clinic.

UNLABELLED: During the last three decades, we have witnessed dramatic improvements in both the psychosocial and pharmacological treatments of affective disorders. Administered in concert with the new medications advances in pharmacology have produced, disorder-specific psychosocial treatments have further improved the prognosis and course of bipolar and unipolar disorder. METHODS: We review our research on unipolar and bipolar disorder and their treatment, in particular interpersonal psychotherapy (IPT) and modifications thereof. RESULTS: We provide empirical evidence that IPT is an efficacious acute and maintenance treatment for affective disorders. Our cumulative research and clinical experience suggest that interpersonal relations and circadian and social rhythms influence affective illnesses and that psychotherapy may aid in normalizing problems in these areas for patients with affective illnesses. CONCLUSIONS: Despite the excitement generated by the recent progress in research on mental disorders and their treatment, we are yet to fulfill the promise that the explosion of knowledge about targeted pharmacotherapies or psychotherapies would seem to offer. To move our field forward, we must continue to apply scientific rigor and thought to understanding the suitability of current nomenclatures, the impact of comorbid psychiatric and medical illnesses and symptoms on the manifestation and treatment of affective disorders, and the practicality of widespread utilization of new treatments.

Aged↗
PubMedDate not supplied

Perceptions of academic vulnerability associated with personal illness: a study of 1,027 students at nine medical schools. Collaborative Research Group on Medical Student Health.

About one quarter of the more than 69,000 medical students in this country suffer symptoms of mental illness, including 7% to 18% with substance use disorders. Subjective distress and physical health needs of medical students are also common and have been linked to training stresses. This first large-scale study of medical student health care examined students' physical and mental health concerns and their perceptions of academic vulnerability associated with personal illness. A 7-page, confidential written survey was given to 1,964 students at nine US medical schools in 1996 and 1997. A total of 1,027 students participated (52% response rate). Nearly all (90%) reported needing care for various health concerns, including 47% having at least one mental health or substance-related health issue. A majority of students expressed a preference for health care outside their training institution, largely due to confidentiality concerns, and 90% preferred health insurance allowing off-site care. Students expressed varying levels of concern about academic jeopardy in association with personal illness, with physical health problems such as arthritis causing the least concern and alcohol and drug abuse triggering the most concern. Consistent differences were detected in these views based on respondent's gender, training level, and institution. Most medical students perceive the need for personal health care. Nevertheless, fear of academic reprisal may prevent medical students from seeking necessary care for their health problems during training. This phenomenon may be linked in important but poorly recognized ways to emerging illness and to impairment among medical students and physicians. Women, minority, and clinical students appear more sensitive to the connection between health and academic vulnerability. Constructive implications for medical school curricula, policies, and health care services are discussed.

Adult↗
PubMedDate not supplied

U.S. women physicians' assessment of the quality of healthcare they receive.

Surveys of women's perceptions of quality and satisfaction with healthcare are widely administered and reported, yet no similar studies of women physicians' perceptions have been conducted. We analyzed related data from the Women Physicians' Health Study, a nationally representative sample of 4501 U.S. women physicians. Among U.S. women physicians, 39% thought the healthcare they personally received was excellent, 37% considered it to be very good, 19% good, 4% fair, and 1% judged their healthcare to be poor quality. Physicians may be especially rigorous judges of healthcare quality, and their assessment of the healthcare they receive is generally positive, an encouraging finding. However, as physicians are highly qualified to assess and potentially obtain high-quality healthcare and as they generally did not judge the care they received to be excellent, the findings also suggest that there are opportunities for improvements in the quality of women's healthcare.

Adult↗
PubMedDate not supplied

Aneurysms of the distal anterior cerebral artery in infants.

Cerebral aneurysms in infants are rare. Of those cases that are reported, only 7 have been identified within the anterior cerebral artery circulation. We report a case of a 7-week-old female who presented with subarachnoid hemorrhage, intracerebral hemorrhage and seizure secondary to a saccular aneurysm of the distal anterior cerebral artery. At surgery, a 1.5-cm thrombosed aneurysm was excised. Postoperatively the child has done well achieving normal milestones at the age of 1 year. We present this case plus a review of the limited number of similar cases found in the literature stressing the presenting signs and symptoms, surgical considerations and outcomes.

Cerebral Angiography↗
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Late infection of a Dacron carotid endarterectomy patch--a case report.

This unique case reports the nonsurgical management of a late (2 years) methicillin-resistant Staphylococcus aureus neck infection around a Dacron-patched carotid endarterectomy. Because the patient was elderly with multiple serious risk factors and no drainable material, IV and oral antibiotics were selected as initial management. Follow-up computed tomography of the neck, however, documented complete resolution of the phlegmon. While the authors remain uncertain of the long-term outcome the patient is free of local infection 2 years after diagnosis and nonoperative treatment.

Aged↗
PubMedDate not supplied

Gender-specific response to depression treatment.

Gender-specific responses to pharmacotherapy or psychotherapy for depression are virtually unknown. Early studies rarely examined treatment response by gender, and the small number of males studied has led to inaccurate comparisons between male and female response. This article addresses conceptual issues and reviews what little can be ascertained from earlier studies of the relationship between gender and treatment outcome. It also presents data from a series of studies conducted over the last 15 years at the University of Pittsburgh School of Medicine.

Adult↗
PubMedDate not supplied

Improved cholesterol-related knowledge and behavior and plasma cholesterol levels in adults during the 1980s.

OBJECTIVES: To determine whether cholesterol-related knowledge and behavior and plasma cholesterol levels were stable until the inception of large-scale national interventions in the middle to late 1980s, whether they subsequently improved, and whether these levels varied by subgroups. DESIGN, SETTING, AND PARTICIPANTS: Data were collected from 4173 adults aged 25 through 74 years in the two control cities (San Luis Obispo and Modesto, Calif) of the Stanford Five-City Project. Five separate, community-based surveys were conducted in 1979-1980, 1981-1982, 1983-1984, 1985-1986, and 1989-1990. RESULTS: Cholesterol-related knowledge and behavior and plasma cholesterol levels improved (P = .0001) in both cities after the early 1980s. Those who were more educated, female, older, or nonsmokers had significantly higher knowledge and behavior scores, and those who were younger, more educated, or normotensive had significantly lower plasma cholesterol levels. CONCLUSION: Improvements in this population's cholesterol-related knowledge and behavior and plasma cholesterol levels began in 1985-1986, suggesting that the extensive cholesterol interventions that began in the middle 1980s in the United States created positive cholesterol-related changes at the community level.

Adult↗